Wong Muh Geot, Pollock Carol A, Cooper Bruce A, Branley Pauline, Collins John F, Craig Jonathan C, Kesselhut Joan, Luxton Grant, Pilmore Andrew, Harris David C, Johnson David W
Department of Renal Medicine, Royal North Shore Hospital, Sydney Medical School, University of Sydney, Sydney, Australia;, †Monash Medical Centre and Eastern Health Renal Units, Melbourne, Australia;, ‡Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand;, §Department of Nephrology, Children's Hospital at Westmead, Sydney School of Public Health, University of Sydney, Sydney, Australia;, ‖Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia;, ¶Centre for Transplantation and Renal Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia, *Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
Clin J Am Soc Nephrol. 2014 Jan;9(1):135-42. doi: 10.2215/CJN.02310213. Epub 2013 Oct 31.
The Initiating Dialysis Early and Late study showed that planned early or late initiation of dialysis, based on the Cockcroft and Gault estimation of GFR, was associated with identical clinical outcomes. This study examined the association of all-cause mortality with estimated GFR at dialysis commencement, which was determined using multiple formulas.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Initiating Dialysis Early and Late trial participants were stratified into tertiles according to the estimated GFR measured by Cockcroft and Gault, Modification of Diet in Renal Disease, or Chronic Kidney Disease-Epidemiology Collaboration formula at dialysis commencement. Patient survival was determined using multivariable Cox proportional hazards model regression.
Only Initiating Dialysis Early and Late trial participants who commenced on dialysis were included in this study (n=768). A total of 275 patients died during the study. After adjustment for age, sex, racial origin, body mass index, diabetes, and cardiovascular disease, no significant differences in survival were observed between estimated GFR tertiles determined by Cockcroft and Gault (lowest tertile adjusted hazard ratio, 1.11; 95% confidence interval, 0.82 to 1.49; middle tertile hazard ratio, 1.29; 95% confidence interval, 0.96 to 1.74; highest tertile reference), Modification of Diet in Renal Disease (lowest tertile hazard ratio, 0.88; 95% confidence interval, 0.63 to 1.24; middle tertile hazard ratio, 1.20; 95% confidence interval, 0.90 to 1.61; highest tertile reference), and Chronic Kidney Disease-Epidemiology Collaboration equations (lowest tertile hazard ratio, 0.93; 95% confidence interval, 0.67 to 1.27; middle tertile hazard ratio, 1.15; 95% confidence interval, 0.86 to 1.54; highest tertile reference).
Estimated GFR at dialysis commencement was not significantly associated with patient survival, regardless of the formula used. However, a clinically important association cannot be excluded, because observed confidence intervals were wide.
“早期与晚期开始透析”研究表明，基于Cockcroft和Gault对肾小球滤过率（GFR）的估算，计划早期或晚期开始透析，其临床结局相同。本研究探讨了透析开始时估算的GFR与全因死亡率之间的关联，该估算使用了多种公式。
设计、地点、参与者及测量方法：“早期与晚期开始透析”试验的参与者根据透析开始时用Cockcroft和Gault公式、肾脏疾病饮食改良公式或慢性肾脏病流行病学协作公式测得的估算GFR分为三分位数。使用多变量Cox比例风险模型回归确定患者生存率。
本研究仅纳入了开始透析的“早期与晚期开始透析”试验参与者（n = 768）。研究期间共有275例患者死亡。在对年龄、性别、种族、体重指数、糖尿病和心血管疾病进行校正后，Cockcroft和Gault公式确定的估算GFR三分位数之间（最低三分位校正风险比为1.11；95%置信区间为0.82至1.49；中间三分位风险比为1.29；95%置信区间为0.96至1.74；最高三分位为参照）、肾脏疾病饮食改良公式确定的估算GFR三分位数之间（最低三分位风险比为0.88；95%置信区间为0.63至1.24；中间三分位风险比为1.20；95%置信区间为0.90至1.61；最高三分位为参照）以及慢性肾脏病流行病学协作公式确定的估算GFR三分位数之间（最低三分位风险比为0.93；95%置信区间为0.67至1.27；中间三分位风险比为1.15；95%置信区间为0.86至1.54；最高三分位为参照），生存率均未观察到显著差异。
无论使用何种公式，透析开始时估算的GFR与患者生存率均无显著关联。然而，由于观察到的置信区间较宽，不能排除存在临床上重要关联的可能性。
